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Related Experiment Video

Updated: Jul 28, 2026

Induction of Nephrotic Syndrome in Mice by Retrobulbar Injection of Doxorubicin and Prevention of Volume Retention by Sustained Release Aprotinin

Induction of Nephrotic Syndrome in Mice by Retrobulbar Injection of Doxorubicin and Prevention of Volume Retention by Sustained Release Aprotinin

Published on: May 6, 2018

Anion gap and hypoalbuminemia

J Figge¹, A Jabor, A Kazda

¹Department of Medicine, St. Peter's Hospital, State University of New York, Albany, USA.

Critical Care Medicine

|November 21, 1998

Summary

Hypoalbuminemia can falsely lower the anion gap, masking acidosis. A simple correction factor adjusts the anion gap for low serum albumin levels, improving diagnostic accuracy.

Area of Science:

Clinical Chemistry
Critical Care Medicine
Acid-Base Balance

Background:

Hypoalbuminemia is prevalent in critically ill patients.
Low serum albumin can significantly decrease the measured anion gap.
This reduction may obscure the presence of a high anion gap metabolic acidosis.

Purpose of the Study:

To demonstrate how hypoalbuminemia lowers the anion gap.
To derive a correction factor for the anion gap in hypoalbuminemia.
To improve the diagnostic utility of the anion gap in clinical practice.

Main Methods:

Observational study design.
Analysis of arterial blood samples from critically ill patients and normal subjects.
Measurement of electrolytes, proteins, pH, and PCO2.

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Main Results:

Hypoalbuminemia was observed in 49% of critically ill patients.
Each 1 g/L decrease in serum albumin led to a 0.25 mEq/L underestimation of the anion gap.
A strong correlation (r2 = .94) was found between albumin levels and anion gap deviation.

Conclusions:

A formula was derived to adjust the anion gap for serum albumin concentration.
Adjusted anion gap = observed anion gap + 0.25 x ([normal albumin] - [observed albumin]) (in g/L).
This adjustment standardizes the anion gap, aiding in the diagnosis of metabolic acidosis.